Evidence-Based Acute Bronchitis Therapy Kimberly L. Tackett, PharmD, BCPS, CDE 1 , and Aaron Atkins, PharmD 1 Abstract Acute bronchitis is a disease characterized by inflammation of the large airways within the lung accompanied by a cough lasting from 1 to 3 weeks. The inflammation occurs as a result of an airway infection or environmental trigger, with viral infections accounting for an estimated 89% to 95% of cases. Symptomatic treatment of cough is primarily required for patients, though in most cases the condition is self-limiting. Therapy consists of both nonpharmacological and pharmacological options to include antibiotics and antivirals, antitussive agents, protussive agents, and beta-2-agonists. This article reviews the treatment options for acute bronchitis and recommends criteria for use. Keywords acute bronchitis, respiratory illness, acute cough, respiratory inflammation, upper airway infection AB is a 75-year-old male presenting to the emergency depart- ment with a chief complaint of cough for 10 days with purulent sputum and shortness of breath. The patient has a past medical history of stabilized congestive heart failure without a history of pulmonary disease. Vital signs include a temperature of 99.1 F, respiratory rate of 20 breaths/min, and a heart rate of 91 beats/min. On auscultation of the lungs wheezing is present without rales. AB reports an allergy to azithromycin. Introduction Acute bronchitis is the fifth most common diagnosis for patients presenting with a primary symptom of cough lasting from 1 to 3 weeks. 1,2 The disease is characterized by inflammation of the large airways within the lung accompanied by a cough without the presence of pneumonia as confirmed by the absence of an infiltrate on chest radiograph. 3 The cough may last for up to 3 weeks in about 50% of patients due to either an infectious or a noninfectious etiology. 4 No matter the etiology, the triggering factor leads to an inflammatory response within the epithelium of the bronchi caus- ing mucus production and airway hyperresponsiveness. There are an estimated 10 million office visits per year by patients seeking medical attention for acute bronchitis, leading to 10 ambulatory visits per 1000 people/year. 1 A large part of treatment costs are a consequence of patients receiving on aver- age two prescriptions per visit and the disease resulting in 2 to 3 days of missed work. 5 Office visits for acute bronchitis result in a prescription for antimicrobial therapy in 70% to 90% of the cases, though most cases are due to a virus. 2 Pathogenesis Acute bronchitis is an inflammation of the epithelium of the bronchi secondary to an airway infection or environmental trigger that clinically presents as a cough. 2 Viral infections account for an estimated 85% to 95% of acute bronchitis cases with bacterial causes being more common in patients with chronic health problems. 3 The most frequently isolated viruses include influenza A and B, parainfluenza, and respira- tory syncytial virus, while coronavirus, adenovirus, and rhino- virus are encountered less commonly. Bacterial pathogens involved are those that cause community-acquired pneumonia such as Mycoplasma pneumonia, Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis, and Bordetella pertussis. Diagnosis The diagnosis of acute bronchitis is primarily clinical since there are no specific diagnostic criteria. It should be differ- entiated from asthma or bronchiolitis which presents as a progressively worsening cough along with wheezing, short- ness of breath, and hypoxemia. 4 Many patients misdiag- nosed with acute bronchitis are actually presenting with acute cough due to asthma exacerbation, the common cold, or acute exacerbation of chronic obstructive pulmonary dis- ease (COPD). 1 A thorough assessment of the patient should be performed to rule out other causes of the cough including a physical examination, medication and social history, and tobacco use evaluation. Distinguishing acute bronchitis from 1 South University School of Pharmacy, Savannah, GA, USA Corresponding Author: Kimberly L. Tackett, South University School of Pharmacy 709 Mall Boulevard, Savannah, GA 31406, USA Email: [email protected] Journal of Pharmacy Practice 25(6) 586-590 ª The Author(s) 2012 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0897190012460826 http://jpp.sagepub.com
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